Provider Demographics
NPI:1063027548
Name:HENRIKSON, MATTHEW KARL, OWEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:KARL, OWEN
Last Name:HENRIKSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1598 ROCK SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3166
Mailing Address - Country:US
Mailing Address - Phone:678-814-5705
Mailing Address - Fax:
Practice Address - Street 1:885 WOODSTOCK RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2277
Practice Address - Country:US
Practice Address - Phone:678-814-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010245111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner